Intervention Summary

Curriculum-Based Support Group (CBSG) Program

The Curriculum-Based Support Group (CBSG) Program is a support group intervention designed to increase resiliency and reduce risk factors among children and youth ages 4-17 who are identified as being at elevated risk for early substance use and future delinquency and violence (e.g., they are living in adverse family situations, displaying observable gaps in coping and social skills, or displaying early indicators of antisocial attitudes and behaviors).

Based on cognitive-behavioral and competence-enhancement models of prevention, the CBSG Program teaches essential life skills and offers emotional support to help children and youth cope with difficult family situations; resist peer pressure; set and achieve goals; refuse alcohol, tobacco, and other drugs; and reduce antisocial attitudes and rebellious behavior. Delivered in 10-12 weekly, 1-hour support group sessions, the curriculum addresses topics such as self-concept, anger and other feelings, dreams and goal setting, healthy choices, friends, peer pressure, life challenges, family chemical dependency, and making a public commitment to staying drug free and true to life goals. Lesson content and objectives are essentially the same for all participants but are tailored for age and developmental status.

Groups are formed with 6-10 participants no more than 2 years apart in age and are led by trained adult facilitators and cofacilitators who follow the program facilitator's manual. Students ages 8-11 participated in the study reviewed for this summary.

The CBSG Program was developed in Texas in 1982 and was implemented first in community-based settings and then in schools. An adaptation for use in homeless and domestic violence shelters, group homes, and other transitional settings was developed with a 5-year demonstration grant from the Center for Substance Abuse Prevention and in partnership with the University of Texas at Arlington and the Texas Commission on Alcohol and Drug Abuse. Since dissemination of the program began in 1984, more than 17,000 youth service professionals have been trained to implement the program in more than 2,400 schools and community-based sites in 32 States, and 1.6 million children and youth have participated in the program.

NIH Funding/CER Studies

Partially/fully funded by National Institutes of Health: NoEvaluated in comparative effectiveness research studies: No

Adaptations

The program has been adapted for use in Christian faith-based settings and in homeless and domestic violence shelters, group homes, and other transitional settings. All program handouts have been translated into Spanish.

Adverse Effects

No adverse effects, concerns, or unintended consequences were identified by the developer.

IOM Prevention Categories

SelectiveIndicated

Quality of Research

Review Date: April 2010

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.

Outcomes

Antisocial attitudes were assessed using a 4-item self-report scale from the 2003 CBSG Program Pre/Post Survey. The 4 items, adapted from the Student Survey of Risk and Protective Factors, were:

"I think it is ok to take something without asking if you can get away with it."

"I think it is all right to cheat at school."

"I think it is all right to beat up people if they start a fight."

"You should tell the truth even if you are going to get in trouble."

Response options were 0 (never), 1 (sometimes), and 2 (always). A composite score was created across all items.

Key Findings

Students identified by school counselors and faculty as being at elevated risk for early substance use and future delinquency and violence were randomly assigned to the intervention group or to a nonintervention control group. From pre- to posttest, intervention group students had a significant decrease in antisocial attitudes compared with control group students (p < .05).

Rebellious behavior was assessed using a 3-item self-report scale from the 2003 CBSG Program Pre/Post Survey. The 3 items, adapted from the Student Survey of Risk and Protective Factors, were:

"I do the opposite of what people tell me, just to get them mad."

"I like to see how much I can do before I get in trouble."

"I don't follow rules that I don't like."

Response options were 0 (never), 1 (sometimes), and 2 (always). A composite score was created across all items.

Key Findings

Students identified by school counselors and faculty as being at elevated risk for early substance use and future delinquency and violence were randomly assigned to the intervention group or to a nonintervention control group. From pre- to posttest, intervention group students had a significant decrease in self-reported rebellious behavior compared with control group students (p < .05).

Attitudes and intentions about substance use were assessed using a 10-item self-report scale from the 2003 CBSG Program Pre/Post Survey. The 10 items, which were extracted from the Individual Protective Factors Index and used without modification, were:

"I might smoke cigarettes when I get older."

"Grown ups have more fun when they drink."

"I will probably drink alcohol when I am old enough."

"It is ok to use drugs if you don't get caught."

"Drugs like marijuana and cocaine should be ok for kids to use."

"If I have a choice, I might try drugs."

"Marijuana makes you happy."

"People usually drink alcohol at parties."

"I can't wait to be old enough to drink."

"I am curious about alcohol and drugs."

Response options were 1 (no or never), 2 (I don't think so), 3 (maybe), and 4 (yes, definitely). A composite score was created across all items.

Key Findings

Students identified by school counselors and faculty as being at elevated risk for early substance use and future delinquency and violence were randomly assigned to the intervention group or to a nonintervention control group. From pre- to posttest, intervention group students had a significant increase in anti-substance use attitudes and intentions compared with control group students (p < .05).

Substance use was assessed using 5 self-report items from the 2003 CBSG Program Pre/Post Survey. The 5 items, adapted from the Monitoring the Future questionnaire, asked on how many of the past 30 days the student used the following drugs: alcohol, marijuana, inhalants, other illegal drugs, and any type of tobacco. Response options were 0 days, 1-2 days, 3-4 days, and 5 or more days.

Key Findings

Students identified by school counselors and faculty as being at elevated risk for early substance use and future delinquency and violence were randomly assigned to the intervention group or to a nonintervention control group. From pre- to posttest, self-reported inhalant use decreased among intervention group students and increased among control group students (p < .05). No significant difference was found between groups on the other four categories of substances.

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:

Reliability of measures

Validity of measures

Intervention fidelity

Missing data and attrition

Potential confounding variables

Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome

Reliability
of Measures

Validity
of Measures

Fidelity

Missing
Data/Attrition

Confounding
Variables

Data
Analysis

Overall
Rating

1: Antisocial attitudes

3.3

3.8

4.0

4.0

3.5

3.8

3.7

2: Rebellious behavior

3.3

3.8

4.0

4.0

3.5

3.8

3.7

3: Attitudes and intentions about substance use

3.3

3.8

4.0

4.0

3.5

3.8

3.7

4: Substance use

3.3

3.8

4.0

4.0

3.5

3.8

3.7

Study Strengths

The scales and items used to measure attitudes and behaviors in this study have very good content and criterion validity. Intervention fidelity procedures were adequately documented (i.e., use of orientation and training for staff; attendance sheets; fidelity checklist; randomized, systematic observation; and adherence guidelines). Missing data and attrition were minimal (attrition was 9% for the intervention group and 11% for the control group) and were accounted for using data imputation methods. Randomization into study groups minimized the potential for confounding variables. Data analysis techniques were appropriate.

Study Weaknesses

Reliability coefficients for most of the scales and items were modest.

Readiness for Dissemination

Review Date: April 2010

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.

Dissemination Strengths

Comprehensive implementation materials include manuals that are sequentially structured, are easy to read and follow, and include exercises that are well described and planned. All handouts necessary for implementation are included in the materials and can be replicated as needed. Implementers are required to participate in a 2-day training, either on site or at locations in Texas. The training addresses the theoretical basis for the program, outlines the steps involved in implementation, and provides guidance for handling sensitive and challenging issues. Ongoing technical assistance is provided via telephone consultation. Developers place considerable emphasis on identifying and recruiting facilitators with the skills and personal characteristics required for successful program implementation. New sites are required to supervise facilitators and conduct an annual evaluation. Detailed quality assurance materials are accompanied by detailed instructions on use.

Dissemination Weaknesses

Some organizations may find it difficult to correctly implement the manuals, which are extensive and dense. The manuals refer to "mom and dad," terms that may not apply to all families. Because the supervisor at the implementing site is not required to participate in training, it is not clear how this person provides oversight to facilitators.

Costs

The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.